甘肃省迭部和铧尖地区4种蜱自然感染莱姆病伯氏疏螺旋体的调查

目的 调查甘肃省迭部和铧尖地区4种蜱自然感染莱姆病伯氏疏螺旋体(Bb)情况,为莱姆病的防治提供科学依据。方法 2010年3月至6月,在甘肃省迭部和铧尖地区岷山北麓迭部林区（秦岭山脉）和肃南祁连山北麓铧尖林区,对4种优势蜱（森林革蜱、草原革蜱、日本血蜱和青海血蜱）自然感染莱姆病Bb进行流行病学检测。采用夹夜法,每隔10 m布夹,晚放晨收,将捕获的啮齿类动物逆毛检虫法采集寄生蜱,同时采用拖旗法采集游离蜱。对采集的4种活的成蜱,清洗消毒后解剖取其中肠内容物分别涂片,置暗视野镜下观察莱姆病Bb;对所分离到的螺旋体再用Bb单克隆和多克隆抗体鉴别试验加以证实。结果 共采集到蜱类2科8属36种,即硬蜱科6属33种,软蜱科2属3种。解剖森林革蜱、草原革蜱、日本血蜱和草原硬蜱4种201只蜱的肠道,暗视野观察出携带莱姆病Bb的阳性蜱25只,阳性率为12.44％(25/201);接种培养森林革蜱、草原革蜱和日本血蜱3种65只蜱,从12只蜱体内培养分离出莱姆病Bb,阳性率为18.46％(12/65)。结论 森林革蜱、草原革蜱和日本血蜱均有程度不同地莱姆病Bb的自然感染。     

我国若干蜱媒疾病概况

蜱是传播病原体种类最多的节肢动物。近年来,随着发病率的升高,蜱媒疾病越来越引起世界的关注。本文对我国常见的几种蜱媒疾病如发热伴血小板减少综合征、莱姆病、巴贝虫病及蜱传脑炎的流行特点、临床表现、诊断方法和病原治疗进行综述。     

从福建北部林区粒形硬蜱体内分离出一株莱姆病螺旋体

从福建北部已发现莱姆病病例的林区捕获一批粒形硬蜱,取其中肠接种于BSKⅡ培养基,结果分离出一株莱姆病螺旋体(Borrelia burgdorferi),从该蜱分离出莱姆病病原体在国内外属首次报告。     

吉林林区动物莱姆病螺旋体感染的调查研究

目的了解吉林珲春林区的蜱、野鼠及牛、绵羊感染莱姆病的情况。方法对蜱和野鼠进行莱姆病螺旋体的PCR扩增,阳性标本RFLP分型,应用间接免疫荧光法检测家畜血清中的IgG抗体。结果PCR检测全沟硬蜱和森林革蜱的带菌率为36.0%和30.9%;在五种鼠中检测到莱姆病螺旋体的特异性片段,带菌率分别为14.0%、8.3%、13.0%、25.0%和33.3%。阳性标本RFLP分型结果属于B.garinii和B.afzelii型;牛、羊血清学检测阳性率为27.5%和31.5%。结论野鼠、蜱和牛羊中都检测到伯氏疏螺旋体的感染,证实吉林珲春林区存在莱姆病的自然疫源地。     

吸血期蓖麻硬蜱雌虫体内周身性莱姆病螺旋体生长动态的组织学研究

为查明吸血期蓖麻硬蜱雌虫体内周身性莱姆病螺旋体生长动态,用直接免疫荧光试验、银染色组织学及电子显微镜技术,对饥饿及吸血期蓖麻硬蜱雌虫脑、唾液腺和卵巢组织中莱姆病螺旋体的分布和数量进行了观察。结果显示,饥饿蟀组织中螺旋体数量极为有限,吸血期蜱组织中螺旋体的密度和数量随吸血时间的延长而快速增长,至开始吸血后4或5天,脑、唾液腺和卵巢组织中螺旋体的数量都已达到无法计数的程度;本研究首次对周身性莱姆病螺旋体的分裂增殖提出了假设。螺旋体在吸血期蜱唾液腺的大量检出,为莱姆病螺旋体经由蜱唾液分泌而传播给脊椎动物宿主的假设提供了新的证据。     

莱姆病防治专家共识

莱姆病是一种经蜱叮咬传播由伯氏疏螺旋体感染所致的人兽共患自然疫源性疾病,主要流行于温带和亚热带地区。该病系全身性疾病,可影响皮肤、关节、神经系统和心脏等多种脏器。莱姆病临床表现多样,诊断困难,易造成误诊和漏诊,若患者得不到早期诊断和及时治疗,致残率较高,对人类健康危害甚大。中国微生物学会人兽共患病病原专业委员会和中国医药生物技术协会生物诊断技术分会的专家学者,梳理莱姆病的流行病学、病原学、临床表现、实验室检测、诊断和治疗进展,综合总结,形成了本共识。旨在向临床医师和公共卫生人员提供指导性建议,从而更好的防治莱姆病。     

我国部分地区蜱中莱姆病螺旋体的检测与基因分型研究

目的 对我国部分地区的多种蜱类进行莱姆病螺旋体的检测和基因分型。方法 选择我国黑龙江、吉林和浙江省部分林区为调查点，采集当地蜱类，用巢式PCR法进行检测，阳性产物进行限制性片段长度多态性（RFLP）分析和单链构象多态性（SSCP）分析，确定莱姆病螺旋体的基因型。结果 共检测蜱512只，阳性126只，阳性率24．61％。其中吉林全沟硬蜱带菌率为37．00％，黑龙江全沟硬蜱带菌率为20．87％，浙江长角血蜱带菌率为28．07％。RFLP分析表明，蜱中莱姆病螺旋体包括B．garinii和B．afzelii两种基因型。SSCP分析显示为7种亚型，其中B．garinii分为5个亚型，B．afzelii分为2个亚型。发现有3只蜱同时感染不同基因（亚）型莱姆病螺旋体。结论 证实B．garinii和B．afzelii基因型为我国莱姆病螺旋体的优势基因型，并在我国蜱中发现莱姆病螺旋体不同基因（亚）型的混合感染。     

吉林省莱姆病流行病学调查

目的对吉林省9个地区,进行莱姆病疫源地地理分布调查。方法按[莱姆病流行病学个案调查表]的内容进行了人群、动物感染率,媒介蜱带菌率、蜱活动规律消长时间、生存条件等调查。对吉林省莱姆病自然疫源地的分布,地理景观进行分析。对山区、半山区、平原调查的数据进行了统计学处理。结果吉林省9个地区35个市县、55个乡镇的3561人群蜱叮咬率为91.00%、2292人群感染率为6.20%。马、牛、羊、狗、野鼠5种动物2499份调查,感染率为22.13%。抓捕的3570媒介蜱带菌率为35.80%。结论调查结果证明,吉林省9个地区及旅游景点存在莱姆病疫源地,莱姆病并非属林业型疾病。     

大连市莱姆病血清流行病学调查

莱姆病是蜱传疏螺旋体病，是一种新的人畜共患病。它是由美国医师Steers于1977年首先调查发现。1982年莱姆病的病原分离成功，使该病在流行病学、临床过程、诊断．治疗等方面的研究取得快速进展。我国自1987年中国预防医学科学院流行病学微生物学研究所在22个省（市、区）开展莱姆病的研究证实，莱姆病在我国分布相当广泛，东北和内蒙古林区是主要疫区，辽宁东部山区存在莱姆病及其自然疫源地。为摸清大连地区是否存在莱姆病，于1994年至1995年随机抽样对市内居民和庄河市（县级市）3个农村乡镇居民，进行了莱姆病血清流行病学调查；同时对…     

西北新疆等4省区蜱感染莱姆病螺旋体的分子流行病学调查

目的了解我国西北部分省区蜱中莱姆病螺旋体感染及其基因分型情况。方法应用巢式PCR扩增脾中莱姆病螺旋体5S-23S rRNA间隔区片段,对阳性产物进行限制性片段长度多态性（RFLP）分析。结果共检测11个蜱种2 460只,感染莱姆病螺旋体的有11个种304只,阳性率为12.36%。新疆、宁夏、陕西、甘肃的感染率分别为11.31%、17.96、12.35%及11.64%。不同省区阳性率存在差别;不同蜱种间阳性率亦存在明显差别,其中以青海血蜱阳性率最高,达到59.38%。RFLP分析结果显示西北四省区蜱中莱姆病螺旋体为B.garinii及B.afzelii基因型,其中B.garinii基因型为主要基因型,占80%以上。结论莱姆病螺旋体在我国西北4省区中广泛存在,存在B.garinii及B.afzelii两种基因型。     

Clinical evaluation of guidelines and two-test approach for lyme disease.

OBJECTIVE: The diagnosis of Lyme disease should be based on objective clinical signs and symptoms. In a clinical study, we have evaluated whether the recommended two-step approach for serodiagnosis of Lyme disease is useful in daily clinical practice and can influence clinical decision making. METHODS: The signs and symptoms of patients with ongoing musculoskeletal complaints, assumed by their referring physician or themselves to be attributable to active or chronic Lyme disease, and of patients diagnosed as having Lyme disease, were evaluated. On the basis of clinical evaluation only, patients were classified into three groups: previous Lyme disease, active Lyme disease and no Lyme disease. Antibodies to Borrelia burgdorferi were determined by means of an enzyme-linked immunosorbent assay (ELISA), followed, when positive, by immunoblotting. RESULTS: One hundred and three patients (41 males and 62 females, mean age 48.7 yr) participated in the study. Of the 49 patients classified as previous Lyme disease, 25 (51%) had antibodies to B. burgdorferi. All 10 patients with active Lyme disease had positive antibodies and 12 of the 44 patients (27%) classified as no Lyme disease had positive antibodies. No statistically significant differences were found between the percentage of positive immunoblots from patients with previous Lyme disease (72%) and patients with active Lyme disease (100%). In the group of no Lyme disease, five out of 12 patients had a negative immunoblot. Concerning serological testing, immunoblotting could have added additional information. However, immunoblotting did not influence clinical decision making in this group of patients. CONCLUSION: Immunoblotting did not influence clinical decision making for the 47 patients with antibodies to B. burgdorferi in this study.     

莱姆病治疗进展

莱姆病是一种由伯氏疏螺旋体所引起的,以硬蜱为主要传播媒介的自然疫源性疾病。对莱姆病的治疗主要是早期使用抗生素。莱姆病是一种全身性慢性传染病,临床表现复杂多样,侵犯多系统多器官引起损伤,根据其病程发展可分为早中晚三期,而针对不同分期、不同表现及不同发病人群的莱姆病其治疗方法又各不相同,本文将对此进行详细综述。     

Frühdiagnostik der Lyme-Arthritis

Lyme-Arthritis is one of the most frequent manifestations of Lyme disease. Transient arthritides may already develop in the early disease stage. However, typical Lyme arthritis manifests weeks to months after the infection as intermittent mon- or oligoarthritis predominantly affecting the knees. Massive knee effusions may lead to popliteal cysts that often rupture. Chronic arthritides are rare.The diagnosis of Lyme arthritis mainly is based on clinical grounds and confirmed by laboratory tests. Direct detection of the causing agent by culture is difficult and not suitable for clinical use. With polymerase chain reaction based assays in up to 80% of untreated patients with Lyme arthritis B. burgdorferi DNA can be detected in joint fluid or synovial membrane specimens. While this method is not widely available yet it will become a routine diagnostic tool in Lyme arthritis in the near future.Borrelia serology is still the most important laboratory test. A negative serology almost certainly rules out Lyme arthritis. A positive serology alone, however, does not proof Lyme disease and must be critically interpreted in context with clinical symptoms.     

Summary of the first 100 patients seen at a Lyme disease referral center

PURPOSE AND PATIENTS AND METHODS: Lyme disease is a major clinical problem in a number of endemic areas in the United States. In areas where anxiety about the disease is high, patients and physicians often ascribe clinical concerns to Lyme disease. Incorrect diagnosis often leads to unnecessary antibiotic treatment (often prolonged or repeated intravenous therapy). This report summarizes the cases of the first 100 patients referred to the Lyme Disease Center at Robert Wood Johnson Medical School. RESULTS: In only 37 of the patients referred was Lyme disease, either current or preceding, the explanation for the complaints. Many of the patients had another definable arthropathy. Twenty-five of the patients had fibromyalgia, which has not previously been reported in Lyme disease. Three of these patients had active Lyme disease at the time of evaluation, and 17 had a history suggesting preceding Lyme disease. Approximately half of the 91 courses of antibiotic therapy given to these 100 patients before referral were probably unwarranted. CONCLUSIONS: Anxiety about possible late manifestations of Lyme disease has made Lyme disease a "diagnosis of exclusion" in many endemic areas. Persistence of mild to moderate symptoms after adequate therapy and misdiagnosis of fibromyalgia and fatigue may incorrectly suggest persistence of infection, leading to further antibiotic therapy. Attention to patient anxiety and increased awareness of these musculoskeletal problems after therapy should decrease unnecessary therapy of previously treated Lyme disease.     

Epidemiology, clinical features, and diagnosis of Lyme disease.

Lyme disease is the most common vector-borne disease in the United States. Epidemiologic research has contributed to a better understanding of the factors involved in the geographic spread and increased incidence of the disease. Clinical features of Lyme disease, including skin, joint, cardiac, and neurologic involvement, are discussed here, along with recent studies that better characterize these clinical manifestations and more clearly define their immunopathogenesis. The diagnosis of Lyme disease is based on the clinical presentation. Laboratory testing may be helpful but has significant limitations, which we discuss in our review.     

Cost-effectiveness analysis of the Lyme disease vaccine

OBJECTIVE: A vaccine for Lyme disease was approved in 1998 for use in the US. Given the high cost of the vaccine, the low risk of Lyme disease in many areas, and the largely curable nature of the disease, the cost-effectiveness of the vaccine in various risk groups is uncertain. This study was undertaken to examine the cost-effectiveness of the Lyme disease vaccine and the factors that influence its cost-effectiveness. METHODS: We constructed a Markov decision-analysis model to evaluate the clinical effectiveness and cost-effectiveness of the Lyme disease vaccine in populations at various levels of risk for the disease. The probabilities of clinical events and costs were estimated from reports in the literature. Sensitivity analyses assessed the impact of potential variations of parameters on model results. RESULTS: At the average national incidence of Lyme disease (0.0067%), the incremental cost-effectiveness of vaccination was approximately $1,600,000 per case averted when a yearly booster was given for 10 years after the standard initial vaccination regimen of 3 inoculations at 0, 1, and 12 months. For populations with an annual Lyme disease incidence of 1% (the incidence in several well-defined geographical areas of the US), the incremental cost-effectiveness was approximately $9,900 per case averted. Disease incidence had to exceed 10% before vaccination with yearly boosters became both more effective and more cost saving than no vaccination. CONCLUSION: The Lyme disease vaccine is cost-effective only for individuals who live in areas where Lyme disease is endemic and who are frequently exposed to ticks.     

Diagnosis of Lyme disease based on dermatologic manifestations

Lyme disease, or Lyme borreliosis, is an infection caused by the spirochete Borrelia burgdorferi, which is most commonly transmitted to humans by a tick bite. Characterized by early and late phases, Lyme disease is a multisystem illness involving the skin, heart, joints, and nervous system. Diagnosis is based predominantly on clinical manifestations, the most specific being dermatologic. Thus, recognizing the dermatologic manifestations of Lyme disease is important for diagnosis and institution of appropriate, effective therapy. Approximately 75% of patients with Lyme disease present with the pathognomonic skin lesion erythema migrans, an expanding erythematous lesion. During early infection, secondary erythema migrans lesions or Borrelia lymphocytoma may occur. Borrelia lymphocytoma commonly presents as an erythematous nodule on the ear lobe or nipple. During late infection, acrodermatitis chronica atrophicans, an erythematous, atrophic plaque unique to Lyme disease may appear; it has been described in about 10% of patients with Lyme disease in Europe. Fibrotic nodules associated with acrodermatitis chronica atrophicans as well as other sclerotic and atrophic lesions, such as morphea, lichen sclerosus et atrophicus, anetoderma, and atrophoderma of Pasini and Pierini, have been seen late in the course of Lyme disease. In a few cases, other sclerodermatous lesions, such as eosinophilic fasciitis and progressive facial hemiatrophy, have been linked to B. burgdorferi infection. We review the cutaneous lesions associated with Lyme disease.     

Lyme disease: recommendations for diagnosis and treatment

The incidence and the endemic range of Lyme disease in the United States have increased steadily since the disease was originally recognized in Lyme, Connecticut, in 1975. Because of the varied clinical manifestations of this illness and the use of unstandardized serologic testing methods, diagnosis is often uncertain and treatment outcomes are often difficult to evaluate. The antibiotic regimens that are commonly used in clinical practice have changed rapidly. They show much regional variation with little critical comparison of treatment results. The clinical diagnosis and the literature on the treatment of the various stages of Lyme disease are reviewed. The reported data are supplemented with recommendations based on 15 years of clinical experience with this illness.     

Lyme arthritis: pathogenesis, clinical presentation, and management

Arthritis is one of the most prominent features of Lyme disease, the tick-borne illness caused by Borrelia burgdorferi. Although the pathogenesis of Lyme arthritis is complex and still under study, the clinical presentation and natural history have been established by long-term observation of untreated and treated patients. This review addresses the clinical presentation of Lyme arthritis as a mono- or oligoarticular relapsing/remitting arthritis primarily affecting the large joints and describes presentations in which arthralgias rather than arthritis are seen. Strategies for diagnosis and treatment are discussed, and methods are reviewed for addressing treatment-refractory Lyme arthritis and arthralgias that may occur after treatment of Lyme disease (sometimes as a component of what is known as the post-Lyme disease syndrome).